What are the clinical applications of D-dimer testing?

Updated: Nov 18, 2019
  • Author: Reka G Szigeti, MD, PhD; Chief Editor: Eric B Staros, MD  more...
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The principal utility of measuring D-dimer is the high NPV of the test in the diagnosis of deep venous thrombosis (DVT) in an appropriate clinical setting. The clinical (pretest) probability (Wells score) of DVT is determined by assessing multiple factors, such as recent or ongoing therapy for cancer, immobilization of the lower extremities, recent major surgeries, localized tenderness, edema, and history of previous DVT. Based on this score, the probability for developing DVT is categorized as low (unlikely to develop) or high (likely to develop).

In the low-moderate group, the NPV of the D-dimer test is 99% among patients aged 60-80 years but drops to 21%-31% if the patient is older than 80 years. Similarly, D-dimer is found to be a very valuable test in pregnant patients; if a pregnant woman has a low pretest probability for DVT, the NPV of a negative D-dimer test result is 100%.

Since D-dimer assumes activation of the coagulation and fibrinolytic systems, it is valuable in the diagnosis and the monitoring of DIC in combination with other parameters.

A 2010 study showed that a low plasma D-dimer level in pediatric patients correlates well with the absence of traumatic brain injury. [7]

In the appropriate setting, the D-dimer test yields a good NPV in the diagnosis of aortic dissection. [8]

In combination with other markers, D-dimer may be useful to differentiate between acute stroke and stroke-mimicking conditions. [9]

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